Percutaneous Internal Ring Suturing (PIRS) - The Benefits of Laparoscopic Inguinal Hernia Repair

Przemysław Karol Wolak, Agnieszka Strzelecka, Aneta Piotrowska-Gall, Piotr Przemysław Wolak, Ilona Piotrowska, Katarzyna Dąbrowska, Joanna Wróbel, Grażyna Nowak-Starz, Przemysław Karol Wolak, Agnieszka Strzelecka, Aneta Piotrowska-Gall, Piotr Przemysław Wolak, Ilona Piotrowska, Katarzyna Dąbrowska, Joanna Wróbel, Grażyna Nowak-Starz

Abstract

Introduction: The laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery.

Purpose: The study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques.

Patients and methods: We conducted a retrospective study that included children aged 0-18 treated using the PIRS technique in 2008-2016. The control group consisted of patients treated with the traditional, open method of inguinal hernia repair. A total of 276 children were qualified for laparoscopic surgery, and there were 274 patients in the control group. A full laparoscopic procedure was performed on 247 patients. Assessment of the pathology of the internal inguinal ring was done in all patients during the laparoscopic procedure. Intraoperatively 79 children had bilateral inguinal hernia diagnosed, 133 right-sided inguinal herniae, and 57 left-sided inguinal herniae. The occurrence of hernia was not confirmed in 7 children, whereas 53 patients had open contralateral patent processus vaginalis. In a case of contralateral patent processus vaginalis, the repair was performed using the PIRS method.

Results: The recurrence of the inguinal hernia was observed in 10 children in the laparoscopic group and in 5 cases in control group. The duration of the procedure was noted and compared to open inguinal hernia repair. There was a statistically shorter duration of the laparoscopic method. In the control group, there were 16 patients with a metachronous contralateral inguinal hernia.

Conclusion: The laparoscopic inguinal hernia repair was associated with a better assessment of hernia pathology, shorter operative time, and lower risk of contralateral hernia repair.

Keywords: PIRS; children; inguinal hernia; laparoscopy.

Conflict of interest statement

The authors declare no conflicts of interest in this work.

© 2022 Wolak et al.

Figures

Figure 1
Figure 1
Preoperative and intraoperative diagnosis vs sex (female).
Figure 2
Figure 2
Preoperative and intraoperative diagnosis vs sex (male).

References

    1. Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetiz C, Brandt ML. Laparoscopic evaluation of the pediatric inguinal hernia—a meta-analysis. J Pediatr Surg. 1998;33:874–879. doi:10.1016/S0022-3468(98)90664-9
    1. Kantor N, Travis N, Wayne C, Nasr A. Laparoscopic versus open inguinal hernia repair in children: which is the true gold-standard? A systematic review and meta-analysis. Pediatr Surg Int. 2019;35(9):1013–1026. doi:10.1007/s00383-019-04521-1
    1. Nakashima M, Ide K, Kawakami K. Laparoscopic versus open repair for inguinal hernia in children: a retrospective cohort study. Surg Today. 2019;49(12):1044–1050. doi:10.1007/s00595-019-01847-0
    1. Dreuning K, Maat S, Twisk J, van Heurn E, Derikx J. Laparoscopic versus open pediatric inguinal hernia repair: state-of-the-art comparison and future perspectives from a meta-analysis. Surg Endosc. 2019;33(10):3177–3191. doi:10.1007/s00464-019-06960-2
    1. Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Outcomes following laparoscopic versus open surgery for pediatric inguinal hernia repair: analysis using a national inpatient database in Japan. J Pediatr Surg. 2019;54(3):577–580. doi:10.1016/j.jpedsurg.2018.03.015
    1. Al-Taher RN, Khrais IA, Alma’aitah S, et al. Is the open approach superior to the laparoscopic hernia repair in children? A retrospective comparative study. Ann Med Surg. 2021;71:102889. doi:10.1016/j.amsu.2021.102889
    1. Patkowski D, Chrzan R, Jaworski W, Apoznański W, Czernik J. Percutaneous internal ring suturing for inguinal hernia repair in children under three months of age. Adv Clin Exp Med. 2006;15:851–856.
    1. Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W. Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech. 2006;16:513–517. doi:10.1089/lap.2006.16.513
    1. Wolak P. Laparoscopy in inguinal hernia and complete androgen insensitivity syndrome in children whether and when to remove the gonads because of cancer? Medical Studies/Studia Medyczne. 2015;31:277–280.
    1. Esposito C, St. Peter SD, Escolino M, Juang D, Settimi A, Holcomb GW. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review. J Laparoendosc Adv Surg Tech. 2014;24:811–818. doi:10.1089/lap.2014.0194
    1. Sajid MS, Ladwa N, Colucci G, Miles WFA, Baig MK, Sains P. Diagnostic laparoscopy through deep inguinal ring: a literature-based review on the forgotten approach to visualize the abdominal cavity during emergency and elective groin hernia repair. Surg Laparosc Endosc Percutan Tech. 2013;23(3):251–254. doi:10.1097/SLE.0b013e31828dacc5
    1. Wenk K, Sick B, Sasse T, Moehrlen U, Meuli M, Vuille-dit-Bille RN. Incidence of metachronous contralateral inguinal hernias in children following unilateral repair — a meta-analysis of prospective studies. J Pediatr Surg. 2015;50:2147–2154. doi:10.1016/j.jpedsurg.2015.08.056
    1. Thomas DT, Göcmen KB, Tulgar S, Boga I. Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: experience with 250 cases. J Pediatr Surg. 2016;51:1330–1335. doi:10.1016/j.jpedsurg.2015.11.024
    1. Chin TW, Pan ML, Lee HC, Tsai HL, Liu CS. Second hernia repairs in children—a nationwide study. J Pediatr Surg. 2015;50:2056–2059. doi:10.1016/j.jpedsurg.2015.08.024
    1. Nataraja R, Mahomed A. Metachronous contralateral pediatric inguinal hernia. Open Access Surgery. 2010;3:87–90.
    1. Watanabe T, Yoshida F, Ohno M, et al. Morphology-based investigation of metachronous inguinal hernia after negative laparoscopic evaluation – is it acquired indirect inguinal hernia? J Pediatr Surg. 2016;51:1548–1551. doi:10.1016/j.jpedsurg.2016.03.008
    1. Miyake H, Fukumoto K, Yamoto M, et al. Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia. J Pediatr Surg. 2017;52(2):317–321. doi:10.1016/j.jpedsurg.2016.11.029
    1. Lee SR, Choi SB. The efficacy of laparoscopic intracorporeal linear suture technique as a strategy for reducing recurrences in pediatric inguinal hernia. Hernia. 2017;21:425–433. doi:10.1007/s10029-016-1546-y
    1. Erginel B, Akin M, Yildiz A, Karadag CA, Sever N, Dokucu AI. Percutaneous internal ring suturing as a first choice laparoscopic inguinal hernia repair method in girls: a single-center study in 148 patients. Pediatr Surg Int. 2016;32:697–700. doi:10.1007/s00383-016-3903-4
    1. Shalaby R, Ismail M, Shehata S, et al. Shalaby technique for efficient single incision laparoscopic pediatric inguinal hernia repair. J Pediatr Surg. 2015;50:1995–2000.
    1. Wolak PK, Patkowski D. Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique - own experience. Wideochir Inne Tech Maloinwazyjne. 2014;9:53–58. doi:10.5114/wiitm.2014.40389
    1. Watanabe T, Nakano M, Endo M. An investigation on the mechanism of contralateral manifestations after unilateral herniorrhaphy in children based on laparoscopic evaluation. J Pediatr Surg. 2008;43:1543–1547. doi:10.1016/j.jpedsurg.2007.11.010
    1. Schier F. Laparoscopic inguinal hernia repair—a prospective personal series of 542 children. J Pediatr Surg. 2006;41:1081–1084. doi:10.1016/j.jpedsurg.2006.02.028
    1. Yang C, Zhang H, Pu J, Mei H, Zheng L, Tong Q. Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systematic review and meta-analysis. J Pediatr Surg. 2011(46):1824–1834.
    1. Shalaby R, Ismail M, Samaha A, et al. Laparoscopic inguinal hernia repair; experience with 874 children. J Pediatr Surg. 2014;49:460–464. doi:10.1016/j.jpedsurg.2013.10.019
    1. Karadağ C, Erginel B, Sever N, Akın M, Yıldız A, Dokucu A. Laparoscopic hernia repair in children: which method is the best? J Exp Clin Med. 2016;33:11–13.
    1. Esposito C, Escolino M, Cortese G, et al. Twenty-year experience with laparoscopic inguinal hernia repair in infants and children: considerations and results on 1833 hernia repairs. Surg Endosc. 2017;31:1461–1468. doi:10.1007/s00464-016-5139-8
    1. Ramaraj A, Fisher JC. Pseudorecurrence following female laparoscopic inguinal hernia repair in children. J Pediatr Surg Case Rep. 2016;12:21–23. doi:10.1016/j.epsc.2016.06.009
    1. Shalaby R, Ismail M, Gouda S, et al. Laparoscopic management of recurrent inguinal hernia in childhood. J Pediatr Surg. 2015;50:1903–1908.
    1. Novotny NM, Puentes MC, Leopold R, Ortega M, Godoy-Lenz J. The burnia: laparoscopic sutureless inguinal hernia repair in girls. J Laparoendosc Adv Surg Tech. 2017;27:430–433. doi:10.1089/lap.2016.0234
    1. Boo YJ, Han HJ, Ji WB, Lee JS. Laparoscopic hernia sac transection and intracorporeal ligation show very low recurrence rate in pediatric inguinal hernia. J Laparoendosc Adv Surg Tech. 2012;22:720–723. doi:10.1089/lap.2012.0040
    1. Gibbons AT, Hanke RE, Casar Berazaluce AM, et al. Recurrence after laparoscopic high ligation in adolescents: a multicenter international retrospective study of ten hospitals. J Pediatr Surg. 2021;56(1):126–129. doi:10.1016/j.jpedsurg.2020.09.026
    1. Esposito C, Turial S, Alicchio F, et al. Laparoscopic repair of incarcerated inguinal hernia. A safe and effective procedure to adopt in children. Hernia. 2013;17:235–239. doi:10.1007/s10029-012-0948-8
    1. Houben CH, Chan KWE, Mou JWC, Tam YH, Lee KH. Irreducible inguinal hernia in children: how serious is it? J Pediatr Surg. 2015;50:1174–1176. doi:10.1016/j.jpedsurg.2014.10.018
    1. Payiziwula J, Zhao P-J, Aierken A, et al. Laparoscopy versus open incarcerated inguinal hernia repair in octogenarians: single-center experience with world review: single-center experience with world review. Surg Laparosc Endosc Percutan Tech. 2019;29(2):138–140. doi:10.1097/SLE.0000000000000629
    1. Hurme T, Lahdes-Vasama T, Makela E, Iber T, Toppari J. Clinical findings in prepubertal girls with inguinal hernia with special reference to the diagnosis of androgen insensitivity syndrome. Scand J Urol Nephrol. 2009;43(1):42–46. doi:10.1080/00365590802299247
    1. Quail JF, Ignacio RC. Appendicitis associated with a strangulated Littre’s hernia. J Pediatr Surg Case Rep. 2015;3:41–43. doi:10.1016/j.epsc.2014.11.018
    1. Kara Ö, Yıldız A, Toydemir HE, et al. Does percutaneous internal ring suturing contain risk of ilioinguinal nerve entrapment? Pediatr Surg Int. 2015;31:485–491.
    1. Ishii T, Yonekura T, Yamauchi K, et al. Laparoscopic repair of sliding inguinal hernia in female children. Pediatr Surg Int. 2016;32(9):895–899. doi:10.1007/s00383-016-3935-9
    1. Wolak PK, Strzelecka A, Piotrowska A, et al. The operative time for unilateral inguinal hernia repair in children performed with Percutaneous Internal Ring Suturing (PIRS) or open approach method. J Clin Med. 2021;10(6):1293. doi:10.3390/jcm10061293

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe